Comparison of Self-Report, Hospital Discharge Codes, and Adjudication of Cardiovascular Events in the Women's Health Initiative

Abstract

Limited information is available from large clinical investigations about the agreement among sources of diagnoses for endpoints. The authors used data from the Women's Health Initiative clinical trials and observational study from January 1994 to November 2000 to evaluate the agreement among self-report, hospital discharge codes, and two different levels of physician review of medical records for cardiovascular endpoints. For myocardial infarction, stroke, pulmonary embolism, and venous thrombosis, the agreement of hospital discharge codes or self-report with review by study physicians at clinical centers was substantial (kappa = 0.64-0.84). For coronary revascularization, agreement among these sources of information was substantial to almost perfect (kappa = 0.79-0.92), but for angina, congestive heart failure, and peripheral vascular disease, concordance was only fair to moderate (kappa = 0.37-0.56), indicating that these endpoints remain difficult to classify reliably. Agreement between physician adjudicators at clinical centers and central physician adjudicators was substantial to almost perfect (kappa = 0.67-0.94). The findings also suggest that, for the endpoint of myocardial infarction, physician review of events with hospital discharge codes for angina and congestive heart failure is an important source of validated events, and for stroke, review of all events with cerebrovascular codes is important.

When are breast cancer patients at highest risk of venous thromboembolism? A cohort study using English health care data

“…7,8,10,34 Previously, our algorithm was shown to have a positive predictive value of 84% when using VTE codes from primary care only. 19 Although this value is higher than that in studies that relied solely on administrative codes for defining VTE, [35][36][37] it could still indicate that some of our VTE cases are liable to be false positives which, if greater than the number of VTE cases not captured by our algorithm, would result in a slight overestimation in absolute risks of VTE in each exposure category. Another limitation of our work is the lack of data on thromboprophylaxis occurring during inpatient episodes, whether for cancer treatments (eg, surgery) or complications of the malignancy.…”

Cardiovascular Events and Death in Children Exposed and Unexposed to ADHD Agents

“…The rationale for this decision was that the first-listed diagnosis is purportedly the diagnosis chiefly responsible for the admission and/or emergency-department visit and has higher positive predictive values (PPVs) in adults. [11][12][13][14][15][16][17][18][19][20] Although claim-based principal diagnoses for these outcomes have been shown to have PPVs of 70% to 94% in adults, [11][12][13][14][15][16][17][18][19][20] their validity had not been measured in children and adolescents. Therefore, we studied the validity of these outcomes by requesting all hospital or emergency-department medical records for those events.…”

Accuracy of ICD‐9‐CM Codes by Hospital Characteristics and Stroke Severity: Paul Coverdell National Acute Stroke Program

“…Disease surveillance and quality‐of‐care studies frequently use information from administrative claims databases, such as Medicare, by identifying patients with specific conditions based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) codes. Studies comparing the accuracy of ICD‐9‐CM codes with medical record review find variations in agreement depending on code selection,2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 as well as patient characteristics, such as age, race/ethnicity,10, 11 sex,11 and length of hospitalization 3. Aside from teaching hospital status10 and hospital departments,16 potential variations in accuracy based on other hospital characteristics are largely unknown.…”